Browsing by Issue Date, starting with "2019-11-13"
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- Healthcare use in multimorbidity patientsPublication . Romana, Guilherme Quinaz; Kislaya, Irina; Gonçalves, Susana; Salvador, Mário Rui; Nunes, Baltazar; Matias Dias, CarlosBackground: The existence of multiple chronic conditions in the same patient is a public health problem, recognized as relevant to health systems. Individuals with multimorbidity have additional health needs, which in the context of continuous increase of life expectancy, imply a heavy burden to healthcare services. Methods: We analysed the association between healthcare use (primary care, medical specialist consultations and hospitalizations) and multimorbidity in the Portuguese population aged 25-74 years old, using the Health Examination Survey (n = 4911) data. Logistic regression models adjusted for predisposing (age, education) and enabling (income, region of residence) factors were fitted separately for male and female. Odds ratios and CI95% were estimated. Results: Prevalence of multimorbidity was 38.3% (95%CI: 35.4%; 41.3%). In males, after adjustment for confounding and when compared to patients without chronic conditions, multimorbidity was associated with greater use of primary care (OR = 3.7; CI95%: 2.3-5.8), medical specialist consultations (OR = 1.9; CI95%: 1.1-3.4) and hospitalizations (OR = 1.8; CI95%: 1.2-2.7). In female, statistically significant association between multimorbidity and healthcare use was observed for primary care (OR = 2.6; CI95%: 1.6-4.3) and medical specialist consultations (OR = 2.8; CI95%: 2.0-3.9), but not for hospitalizations. Both male and female with multimorbidity reported greater use of primary care, compared to individuals with only one chronic condition (OR = 2.4; CI95%: 1.3-4.4 and OR = 1.7; CI95%: 1.1-2.8, respectively). Conclusions: Our results show a greater healthcare use in patients with multimorbidity, both in primary and hospital care. The availability of scientific evidence regarding the healthcare use, by patients with multimorbidity, may substantiate the discussion about the possible need for the Portuguese health system to adapt to these patients, with changes in policies that will allow better and more efficient treatment.
- Crianças com paralisia cerebral em Portugal. É diferente viver nas áreas metropolitanas?Publication . Virella, Daniel; Folha, TeresaIntrodução e Objectivos: Exploraram-se diferenças da apresentação da paralisia cerebral (PC) e de acesso a cuidados diferenciados nas crianças residentes nas áreas metropolitanas. Metodologia: Estudaram-se os casos notificados ao Programa de Vigilância Nacional da Paralisia Cerebral (PVNPC) nascidos em 2001-2010, residentes em Portugal (1841). Exploraram-se associações de dados sobre notificação, avaliação social, clínica e funcional com o local de residência (1816): AM - áreas metropolitanas do Porto e Lisboa (998) e rPT – o resto do País (730); excluíram-se as NUTS III Cávado e Coimbra (88; 5%). Resultados: Não houve diferença nos padrões de classificação pelos tipos clínicos ou pelas escalas de avaliação funcional. Menos residentes no rPT têm subluxação da anca (20%vs.25,5%) mas maior proporção de luxação (2%vs.4%) e proporção semelhante de sonda nasogástrica/ gastrostomia e de epilepsia mas a monoterapia é mais frequente (34%vs.48%). Mais residentes no rPT têm défice visual grave (11,5%vs.16%), a proporção de défices auditivo e de cognição é semelhante. A proporção de crianças provenientes de outras áreas do País é maior em rPT (2%vs.5%) mas há mais nascidos fora de Portugal em AM (11,5%vs.3%). Os residentes em AM têm em menos omissão de avaliação da audição (17%vs.23%) e, marginalmente, da visão (15%vs.19%), mas não da cognição, de luxação da anca ou de realização de RM. Os residentes no rPT têm menos omissão de registo do comprimento (70%vs.51%) e do peso (60%vs.42%). Em AM há maior proporção de notificadores múltiplos (30%vs.24%) e de fontes alternativas de informação (20,5%vs.14%). Conclusões: A afectação clínica e funcional das crianças com PC não é significativamente diferente nas áreas metropolitanas. É necessário melhorar o acesso à avaliação clínica especializada em todo o País.
- The impact of heatwaves on mortality in the Lisbon district – ICARO system revisitedPublication . Bulhosa, Carolina; Antunes, Marília; Nunes, BaltazarTemperature is an environmental factor that influences human comfort and health, so much that both extreme heat and cold increase mortality. Studying the effect that extreme heat has on mortality is of utmost importance, in order to try to predict and mitigate the consequences of global warming, with special attention to the most vulnerable and least adaptive population. In 1991, a heat health warning system that monitors possible increases in mortality due to extreme heat was created - the ICARO system. It was initially developed based on a time series statistical model using dynamic regression techniques and a dynamic threshold, which were calibrated for Lisbon data concerning the 1981 and 1991 heatwaves. The purpose of this work is to formulate a new kind of model to study the heat-mortality relation, aiming to optimise/update the ICARO system. Since the effect of extreme heat on mortality is not limited to the time period when it occurs but is delayed in time, using a model from the family of distributed lag non-linear models (DLNM) seems to be appropriate. A DLNM is based on a bidimensional function, called “cross-basis” function, which describes the shape of the relationship simultaneously along the space of the predictor - temperature -, and along its lag dimension. Therefore, this type of functions allows to explain an exposure-response effect, considering both the intensity and timing of a combination of several past exposures, up to a determined maximum lag. The model proposed here, was calibrated with data from the district of Lisbon from 1980 to 2017, restricted to the months between May and September. The total counts of daily deaths were explained in function of the daily maximum temperatures, through a cross-basis function allowing for a maximum lag of 10 days. The model also accounted for two time functions to control for seasonality and trend. The day of the week and annual average population entered the final model, as well. The results revealed that heat has a sustained effect up to 4 days, causing an overall increase in the relative risk of death for temperatures above 30 oC. However, temperatures below 15 oC during summer confer some protection. The predictive performance of the DLNM and the ICARO model were assessed and compared, through a cross-validation method. It revealed that both models have a good capacity to predict the highest peaks of mortality, but the DLNM tends to underestimate the magnitude of the lower ones. Overall, the DLNM obtained is considered a good model, since it seems to capture at least the main features of the studied relationship. There are some possible future developments for this theme, such as simpler modelling choices for the cross-basis function and accounting for some of the known risk factors for the heat-related mortality.